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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#61

Post by mfoy_ »

EvanAnderson wrote: post #47
mfoy_ wrote: post #42

Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?

I am an American. When I'm particularly exasperated with the healthcare system (usually in the weeks/months following some kind of medical engagement) my answer would be "I don't give a damn which we choose. Let's just make a decision to either socialize medicine completely or let people die." (My mood is unreasonably caustic after dealing with anything medical. The stress of dealing with healthcare billing, health i…

I am so sorry you have to live with that shadow hanging over your head. :(

I know people must get sick of the "holier than thou" attitudes of the nations with universal health care, but it's stories like yours that make it all the more sad... living life only one medical emergency away from financial ruin and destitution...

It's truly a tragedy. It would already be awful enough that you'd be in ER facing a life-threatening situation, but add on looking forward to the bill... holy. fucking. shit.

Re: U.S. health care's widespread overbilling problem

#62

Post by Moshe_Silnorin »

rscho wrote: post #23
Moshe_Silnorin wrote: post #2

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control,…

You are asking me to believe that 2 in 10 people in your country are doctors? And accepting this, prices haven't come down?

Re: U.S. health care's widespread overbilling problem

#63

Post by camiller »

mfoy_ wrote: post #46

"The United States remains one of the only advanced industrialized democracies in the world without universal coverage. While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries l…

I think this is because we choose to live less healthy lifestyles rather than the quality of medical care.

Super size that...

Re: U.S. health care's widespread overbilling problem

#64

Post by rscho »

camiller wrote: post #57
rscho wrote: post #23

Earlier quoted context omitted.

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control,…

According to the WHO the country with the most MD's per capita is Cuba with 7.5 per 1000, while the US has 2.5 per 1000. So at best you come from a country with 3x that of the US, not 100x. Edit: http://gamapserver.who.int/gho/interactive_charts/health_wor...

Indeed, I was misinformed. The ratio is much lower than I thought. I think my point still holds, though.

Re: U.S. health care's widespread overbilling problem

#65

Post by sixdimensional »

tcj_phx wrote: post #45
sixdimensional wrote: post #30

For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine. https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...

There was a reform, maybe sometime around 1985, that replaced "usual, customary and reasonable" with 'what should this procedure actually cost'. Your wikipedia links to this page: Resource-based relative value scale - https://en.wikipedia.org/wiki/Resource-based_relative_value_... It took the government 20 years to figure out that they couldn't give the medical system a blank check. /methinks a helpful medical reform…

Actually, I used to work in health insurance, so I have a bit more insight into this than most, although I've been out of it for a while (10 years or so).

If you look into how the RBRVS are calculated, there is effectively a privately run panel that determines input variables and factors that are used in the RBRVS calculations. At some point, someone has to determine the portion of the calculation that represents "physician value added". While it is true that RBRVS is an alternative system to pure UCR rates, I can assure you that UCR rates still play a major role in many health insurance lines of business and calculations.

By the way, RBRVS aren't the only system that organizations have tried to use to figure out how to bill/cost services - there are also DRG groups (diagnostic related groups), ASC groups (ambulatory surgical center) groups and others.

RBRVS were mainly made to try to control physician office costs in Medicare and are used by HMOs that offer Medicare plans. While other HMOs and private insurers use RBRVS, there are a lot of them that still use UCR (calculated internally) as well.

There was a huge problem around 2009/10 with a big company, Ingenix, that was offering a commercial UCR database which was probably of poor data quality - based on surveys of regional prices from doctor's offices. There were lawsuits, etc. over that and many insurers moved away from commercial sources of UCR and instead brought that in-house. Here's a link that talks a little bit about that: https://www.managedcaremag.com/archives/2009/5/ingenix-after...

Price transparency could help (if it could be achieved), but there are a lot of for-profit organizations who actively try to keep their strategies internal. Transparency might not be enough without pricing controls, but exercising control would be extremely difficult for legal/political/profit motive reasons as well. For that matter, coming up with singular pricing systems that govern controls at scale is incredibly difficult.

Re: U.S. health care's widespread overbilling problem

#66

Post by sixdimensional »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Actually, one way to attack the problem is something Hacker News folk could help with:

Build "open source" coding, grouping and costing schemes and tools to maintain those schemes. It would look something like: 1) a software tool to maintain coding systems, grouping, and related costs (essentially a database front-end); 2) something like Wikipedia/GitHub that maintains version history and controls for coding, grouping and pricing schemes; 3) crowd-sourcing so healthcare professionals and organizations could help maintain the data; and 4) a non-profit, non-governmental organization (maybe something like the Mozilla or Apache foundations) that runs to help govern and provide structured releases of the open coding/grouping/costing data.

These are just my ideas, but having worked in this industry on the problem of health insurance/healthcare fraud and "healthcare cost" - there are a bunch of organizations making a small fortune controlling these schemes (ex. the AMA) - something ripe for disruption (I hate using this word, but it's the truth).

You need quality coding/grouping/costing schemes and systems for the industry to function, but it should be many, many times more open than it currently is.

Re: U.S. health care's widespread overbilling problem

#67

Post by rscho »

Moshe_Silnorin wrote: post #62
rscho wrote: post #23

Earlier quoted context omitted.

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control,…

You are asking me to believe that 2 in 10 people in your country are doctors? And accepting this, prices haven't come down?

I was told that the US had far less MDs than what is actually reported by the WHO. My bad for not checking my sources. However, we apparently have 40 MDs per 10'000. My main point was that doctors salaries have a minor impact on the cost of the whole system, and i think that still holds, though. If you calculate the ratio of the in-pocket sum that goes to the MD compared to the whole bill for a hospital stay, I do not think it is that high. So even if you are right about the guild problem, I don't think that makes it a solution. I admit I did not look at official numbers about that, though.

Re: U.S. health care's widespread overbilling problem

#68

Post by jrs235 »

trey-jones wrote: post #51

At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this: The whole system is fucked. I am referring to the system that facilitates American residents getting healthy and staying that way. What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daught…

A family friend had twins. One born before midnight, the other after (different birth days). When they got their bill(s) from the hospital they noticed they were charging room fees for both infants starting the day of the first born. The second child wasn't even "alive" (born) for the first day they were trying to charge for! What's also absurd is that the first child wasn't in the receiving room until after midnight anyways (since all three, two infants, and mother were in a delivery room until the wee AM hours)!

Re: U.S. health care's widespread overbilling problem

#69

Post by jrs235 »

chiph wrote: post #60

I would love to go to a doctor that had a price board hung in their waiting room so I'd know up front what the cost would be. Well-baby checkup: $120 School sports physical: $150 Blood tests: $80 Minor broken bone: $400 Major broken bone: $1200

"But we don't know [major vs minor] until we look at it!..."

So add what all car shops say:

Hourly rate: $100 / hour.

And begin with a 30 minute to 60 minute diagnostic estimate (providing findings at 30 minute increments).

Re: U.S. health care's widespread overbilling problem

#70

Post by pancreas »

mfoy_ wrote: post #36
EvanAnderson wrote: post #31

Earlier quoted context omitted.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

Why not just have proper socialized medicine, such as in Canada? Instead of this perverse system of "shadow" socialized medicine, fraud, and over-billing, why not just make it come out of everyone's taxes? That way everyone pays a very modest amount in tax and no one has to be financially ruined by flukes of nature. Also kills a huge amount of overhead in the billing departments, collection agencies, insurance compan…

It will be nice to have socialized medicine, but please, not as in Canada. Their system is not good. I would prefer Medicare expansion to all, or a VA-like system while medicare and medicaids are phased out. This will happen eventually, but alas not soon.
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